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In this chapter, I will 1 review the concept and function of projective mechanisms on a psychodynamic basis. In this section, I will outline the relation of projection to the unconscious, its use in innerpsychic dynamics, and the underlying mechanisms for its use in psychotherapy like creativity, imagination, and symbolization; 2 give an overview over the use of projective methods for testing and diagnosis in the psychological sciences; and 3 exemplify the use of projective methods in diagnostics and psychotherapy of children and adolescents.
I will present current methods based on drawing, verbally describing and imaginating, and playing arts, focusing on sand play therapy and miniature figure play. Child and Adolescent Mental Health. Later on, Freud broadened his view of projective mechanisms and refers the term projection to a general primitive mechanism, not only a defense mechanism, implying that projection may also be present when there is no conflict [ 3 ].
This definition seems to be the most common, but also the most over- simplified one. There seem to be no relations to psychoanalytical concepts of the self, or the unconscious. Today, this view can be integrated into the concept of mentalization.
In a critique of projective methods, Lilienfeld et al. This seems to be a misconception of what projective mechanisms are capable of, since it is not an aim to circumvent defense mechanisms but to elucidate them and to work on them in a clinical setting.
Freud lists the free association and the interpretation of dreams as two possible ways to access the unconscious, or at least, processes of the unconscious [ 7 ]. Later, parapraxis [ 8 ], hypnosis [ 9 ], and play [ 10 ] added additional access ways. Of note, here only the mechanism is connoted, its presumable function is regarded as a secondary aspect. Depiction of projective pathways of objects or their representations, respectively.
Inner unconscious objects can either project onto objects in the conscious which are also intrapsychic objects 1 or they can project onto objects in the outer world 2. In reverse, outer objects can project onto inner objects via internatization 3.
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Moreover, intrapsychic unconscious objects can project onto other intrapsychic onconscious objects 4. Finally, objects can project onto intermediate objects 5 , a preferential way in children. For diagnostic purposes and the planning of therapy, an elaborated system for operationalized psychodynamic diagnostics in children and adolescents OPD-CA-2 has been established [ 11 ]. This system is a multiaxial diagnostic and classification system, including psychodynamic, developmental, and clinical aspects.
The axes comprehend interpersonal relations, conflicts, structure, prerequisites for treatment, and the ICD classification. The axes have been aligned to the DSM-5 system [ 12 ]. Currently, no studies have been published evaluating the usefulness of projective techniques with regard to the OPD-CA On the other hand, the psychoanalytic theoretical background of projective techniques proposes a close relationship of the both [ 13 — 15 ]. What can be the functions of projections in intrapsychic dynamics?
Besides the above-mentioned functions as defense mechanism, and developmental characteristic, projections may be used as a translator and connector of distinct and separate representation of objects.
With regard to the object-relations theory [ 16 — 18 ], aspects the self and its conceptualization contributed largely to an expanded understanding of projective mechanisms. Moreover, the connector function might be a possibility to link not closely related objects, or objects of diametrical attributes without generating internal psychological conflicts.
The main prerequisites for the application of projective techniques seem to be creativity, imagination, and the capability of symbolization [ 19 , p.
Of note, these prerequisites depend on the respective developmental level and are influenced by other steps in development, such as speech, conceptualization, abstractive ability, fine and gross motor skills, as well as the level of intelligence. Moreover, the influence of culture, descent and origin, religious belief, moral values, and educational history may strongly contribute to the usefulness of the application of projective techniques in children and adolescents.
Thus, projective techniques such as human figure drawings may not be valid tools of assessment. For example, in cultures where witchcraft and magical forces are present in every-day life, for example in West-African or indigenous cultures of the Americas, deliberate use of the respective test which is to be applied should be made, since these tests may be threatening to the child, or nonprojective mechanisms come into the foreground, diminishing the validity of the test result.
A third aspect is, for example, the connotation of specific animals, such as pigs, as impure. Then the application of the Patte Noire test [ 20 ] may be difficult for children with Islamic or Jewish background.
Thus the child cannot identify with the hero of the story, and the validity of the test is severely restricted. On the other hand, the connotation of specific animals, for example, snakes or rats, in the occidental world is strongly different from the oriental connotations.
A wealth of projective methods has been developed for clinical and nonclinical use, for diagnostics, therapy and personality assessment, and for decision processes in human resource management. Several approaches to classify projective methods have been proposed, and in this chapter, I will follow the taxonomy of Lindzey [ 21 ], suggesting five groups of projective techniques based on the handling of the material.
This classification is also reflected in the title of the present chapter. First, construction techniques provide the material for creative processes such as drawing or writing, for example, pencil and paper for the various drawing tasks.
Second, association techniques involve the presentation of a stimulus, may it be verbal like the wordlist in the C.
Jung experiment of [ 22 ] or nonverbal such as an inkblot. The proband is then asked to provide verbal associations, or a narrative. Third, completion methods provide stimulus material containing blanks, for example incomplete sentences such as in the Washington University Sentence Completion Test SCT [ 23 ], or incomplete stories [ 24 — 26 ].
Additionally, combined material such as comic-like pictures with an empty speech bubble has been used [ 27 ]. Fourth, arrangement or selection methods are based on picture material or building bricks and block, such as the Lowenfeld Mosaic Test [ 28 ]. Fifth, expression techniques involve playful arts material, such as miniature figures as in doll or figurine play [ 29 , 30 ], or expressive sandplay [ 31 — 33 ].
There is no strict separation of these fields, and mostly combined methodologies seem to be in use in the clinical practice. A similar classification has been proposed by Frank [ 34 , 35 ], with constitutive, constructive, interpretive, carthartic, and refractive techniques. A discussion of both classifications is provided by Semeonoff [ 36 ]. Of note, there is a certain overlap between the different categories as well as the different categorization systems.
In general, a three-dimensional model of classification systems has been proposed, containing the various aspects of stimulus, response, and intention Figure 2.
Multidimensional classification system of projective methods. Projective techniques can be classified according to the sensual quality of the stimulus verbal, visual, auditory, etc. There has been a debate on the psychometric properties of diagnostic tests, criteria including norms, reliability, objectivity, validity and incremental validity, and its utility for treatment purposes [ 5 , 6 ], but in the current chapter, I will not add to this debate.
In this case, their clinical use can be assessed by means of the methods of evidence-based medicine, which for example include the evaluation of clinical studies with regard to randomization, blinding, and the description of withdrawals or drop-outs [ 40 , 41 ]. Standardized psychological diagnostics relying on clinical interviews, questionnaires, rating scales, etc.
For example, the standard normal distribution is characterized by its mean value and the standard deviation. Thus, all values obtained smaller or larger than two standard deviations are out of the normal range.
On the other hand, projective techniques aim at describing an individual not relatively to others, but individually. With regard to developing a personalized medicine, this will become more and more important. Psychometric data like standardization, objectivity, validity, and reliability can be obtained using adequate measures, for example, the OPD-CA.
Normalization of data may not be sensible, since most of the projective methods do not aim at placing an individual in a relative order compared to others such as percentile ranks. Projective techniques have also been used in anthropology for cross-cultural studies [ 15 ], with the background that verbal aspects could be eliminated. In summary, the use of projective techniques strongly depended on cultural conceptualization, and surprising results for example with regard to drawing methods have been observed.
For example, in the past, human figure drawings like the Machover Draw-a-Person test [ 42 ] have been applied for the intelligence and developmental measures.
Administered in field studies in Inuit and Cree children, it revealed that the Western conceptualization of intelligence cannot be measured using this task [ 15 , p. In conclusion, a projective test should test projective mechanisms, and not be used for other variables, such as intelligence measures, motor skills, speech development, or questions of child custody, since the validity of this approach is not guaranteed.
In the following section, I will give an overview over the most commonly used projective tests, methods, and techniques applied to children and adolescents. The following descriptions are neither complete nor representative, but they may give a fast first glance on the available techniques. Table 1 gives an overview of available projective tests, methods, and techniques.
Data and tests compiled from [ 15 , 19 , 36 , 43 — 48 ]. Aim: The test aims at detecting the level of intellectual abilities, and was intended as test for school entry qualification. It gives information about the developmental status and the self-esteem of a child. The DAP depends on visual perception, the spatial organization of apperception and the coordination of visual and motor skills.
Only a poor correlation has been found to intelligence tests [ 52 , 53 ], thus the DAP should not be used instead of an intelligence test. References: [ 42 , 49 , 51 , 54 ]. Then the child is invited to explain the drawings.
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Aim: The test aims at measuring personality traits, brain damage and general mental functioning, and developmental psychopathology. Aim: The test aims at detecting developmental retardation and psychopathology. It can be applied in children with various cultural backgrounds. Aim: The test aims at describing the family system and revealing psychic conflicts of the child.
References: [ 58 , 59 ]. Note: Care should be taken with regard to the cultural background of the child with regard to magical experiences see Section 1. Aim: The test aims at detecting personality traits. It is linked to intelligence and developmental status. Additional features like fruit, leaves, or fauna bird, squirrels are noted.
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There are quantitative and qualitative valid data available, based on tree drawings [ 60 ]. References: [ 61 , 62 ]. Description: The proband is given a standardized sheet containing eight square fields with a stimulus in each of the squares lines, dots.
The proband is instructed to complete the stimuli to drawings. The proband is asked to describe each drawing and give a title to each square. References: [ 63 — 65 ]. Note: The test is not based on a common theoretical basis and does show several critical issues [ 66 , 67 ].
Sceno test manual for standardized
Description: The therapist begins with drawing a squiggle any abstract figure, line, scheme, or pictorial element on a sheet of paper. Then roles are reversed and the child starts with a squiggle, which the therapist completes. Both can give verbal comments about the drawing. It is useful to use two different colors for the child and the therapist, respectively, to discriminate between the contributions.